Official Publication of the U.S. Navy Medical Department
Volume 98, No. 2
Surgeon General of the Navy
VADM Donald C. Arthur, MC, USN
Deputy Surgeon General
Deputy Chief, BUMED
RADM John M. Mateczun, MC, USN
Jan Kenneth Herman
Janice Marie Hores
Andre B. Sobocinski
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COVER: Surgeon CAPT Kenneth S.
Kelleher, MC, USN, practices his heal-
ing art in one of NNMC's operating
rooms. Painting by Christine Laubach,
RN, BSN. Photo by HM1 Stephen
Oreski, Navy Medicine Support com-
mand, Bethesda, MD.
We Want Your Opinion
Letters to the Editor are welcome. Please let us know what
you think about Navy Medicine. Please send letters to: Janice
Marie Hores, Managing Editor, Bureau of Medicine and Surgery
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Online issue of Navy Medicine can be found at the GPO
C o n t
22 Juel Loughney: Nurse, Teacher, Mentor, 5 DepartmentRounds
CDR P. Rushton, NQ USN (Ret.) 29 J* Memoriam
Dr. Hermes Grillo
RADM Joseph L. Yon, MC, USN (Ret.)
24 Hidden in Plain View
CAPTP. Collins, NQ USNR, IRet.)
26 Corpsman Down
HM3 R. Ingraham, USN
31 A Look Back
Navy Medicine 1966
NNMC Nurse-Artist Portrays the OR Experience
Nurse Christine Laubach is not content simply with assisting surgeons
as they repair the ravages of war. To her the OR is more a cathedral of
healing where these gifted physicians practice their art. Her art is captur-
ing their skills and dedication on canvas. "I witness firsthand the unfalter-
ing bravery of the men and women of Operation Iraqi Freedom who come
through NNMC, and I am privileged to participate in the many stages of
their healing process. As a nurse, I am so inspired by these heroes, both the
patients and those who dedicate themselves to making them whole again.
"My recent works include an exploration of unfaltering human bravery,
dedication, compassion, conviction, intelligence, focus, and sacrifice. To cap-
ture these qualities, I concentrate on the faces, particularly the surgeons' eyes
and gestures. My initial inspiration was a person who exemplified all these
qualities, my brother, the late CAPT John E. Smathers, USA."
Ms. Laubach's portrait of CAPT Kenneth Kelleher (Cover) is one of several
paintings in her series "Faces of the OR."
"My vision for this series is to explore this human drama of surgeon and
patient through black and white oil on large canvas."
W *| Chief of Naval Operations
CNO Diversity Policy
Diversity is a strategic imperative for the United States Navy.
We defend the greatest nation in the world. It is a nation that welcomes, indeed
encourages, the active participation of every citizen regardless of race, gender, creed
or color—a democracy founded on the promise of opportunity for all. It is also a
nation whose demographic makeup continually changes, reflecting the influx of new
immigrants and the growth of minority populations. The Navy must change with
it. The degree we truly represent our democracy, we are a stronger, more relevant
Diversity is critical to mission accomplishment.
Everyone in our Navy contributes to mission success, and everyone brings to that
collective effort unique capabilities and individual talent. How we harness those
capabilities and foster that talent bears considerable effect on our ability to successfully accomplish the mission.
Like any organization in time of change, we thrive on the infusion of new ideas and the diversity of thought. This
is particularly true today, when understanding the mores, customs and ideals of diverse cultures, as well as the
perspectives of other people, remains critical to winning the long war.
Diversity is a leadership issue, and everyone is a leader.
We will promote and engender a culture that embraces our diversity. Through our communications, educa-
tion, policies, programs and conduct, each of us will actively foster work environments where people are valued,
respected, and provided the opportunity to reach their full personal and professional potential. We will recruit,
develop, educate and retain leaders from and for all parts of our Navy and nation.
We defend the greatest nation in the world. The strength of our diversity directly and irrefutably helps us do
so. The Navy will stay committed to improving that strength.
Admiral, U.S. Navy
Bremerton Family Medicine Residency
Program Receives Top Marks
There's a Family First news
program on a Dallas
Forth Worth television sta-
tion. There's a Family First
political party in Australia.
There's even a self-help aware-
ness Family First group out
of Florida. They all strive
to make families their number one priority. Yet perhaps
there is no place that takes care of families first and devotes
the needed expertise, energy, and commitment than Naval
Hospital Bremerton (NHB) and the Puget Sound Family
Medicine Residency program.
The highly- accredited and highly-rated program helps
handle the medical and healthcare needs of approximately
60,000 active duty service members and eligible beneficiaries,
as well as providing top-notch and highly-sought Graduate
Medical Education for Family Practice Interns and Residents.
"We're affiliated with the WWAMI (Washington, Wyo-
ming, Alaska, Montana, Idaho) Family Medicine Residency
Network," explained CAPT Ron Dommermuth, MC, Pro-
gram Director and Department Head, Puget Sound Family
Medicine Residency. "WWAMI is the number one Residency
training network as decided by US News and World Report
ranking of training programs."
There are four other family practice hospitals under the
umbrella of Navy medicine located at Camp Lejeune NC,
Camp Pendleton CA, Jacksonville FL, and Pensacola FL. Yet
it is NHB that most incoming family physicians-to-be pick
as their top choice.
"We have had the highest rate of students select us as their
preferred place of training over the past 3 years among all five
Navy training programs," said CAPT Dommermuth. "Resi-
dency program members have a lot of personal drive. For
example, the second-year class here had five of six members
score 96 on a recent exam, placing in the top five percent in
the land. Let's face it, it's sunny down in San Diego and else-
where but we simply have great resources, great environment,
and a great locale. We also have great backing from everyone
in the chain of command."According to Dommermuth,
each year, there are about six Medical Corps officers who
complete the 3 -year residency program, which leads to board
certification. The focus is on rural medicine, with clinically-
strong skills, and training that involves all the major medical
"Our overall goal is to produce the best family physicians
we can who are capable of handling all the needs of Navy
families and contribute to our Navy mission anywhere in the
world," said Dommermuth.
NHB and Navy medicine have a long and distinguished
history, from a humble beginning in 1891 on a small gun-
boat at Puget Sound Naval Shipyard before moving to the
present location on Ostrich Bay in 1980. The Puget Sound
Family Medicine Residency program was restored and re-
vamped in 1989, which along with the 3-story Family Care
Center wing added to the hospital in 2001, has proved to be
the perfect venue to train, teach, and treat.
But it's not just the facility itself that attracts. "Our
geographic location definitely helps to attract prospective
students, as does having full and complete support through-
out the facility," Dommermuth commented. "From general
surgery to hospitalists, our program is embraced. Everyone
is personally interviewed by the commanding officer and
asked specifically; "how can we as a command help. The
command really is involved, from the top on down to the
grassroots. That tells our people that we want them and that
they matter. All our candidates who come here are excited
"I came here not only because of the great reputation of
the program, but also because of the area," said LT Mike Mc-
Cord, former Navy enlisted petty officer and current Navy
Medical Resident in the GME program. "I have felt like part
of the overall team since day one. I'm not just a student but a
contributing member of the medical staff helping to improve
the health of our patients."
McCord is in his final year and then is off to Okinawa.
His stint at NHB has included a 2-year "break" where he
served on then USS Camden as a medical officer before re-
suming his graduate medical education.
"The exceptional intern program here prepared me for the
ship," said McCord, "and completing my residency will have
me ready to be a family physician on Okinawa, as well as
ready if called to deploy. We also have a substantial group of
retirees here, many of whom are World War II, Korean War,
and Vietnam War era vets. I have great respect for who they
are and what they did and it's an honor to care for them."
"We are part of the future of family medicine," said Dom-
mermuth "Our goal is to essentially manage the medical
needs of our patients from birth to the grave. We also want
to be specialists in relationships with our patients and all the
varied medical systems so we can help facilitate their com-
"Our doctors leave with a full tool bag to provide rural
family medical needs with a broad package of procedures.
They are all skilled in a wide variety of needs, techniques, de-
liveries, and taskings. They have to be comfortable with what
they do, and who they are asked to meet and treat."
The tool bag they take with them might very well be
put to use as a general medicine officer who is haze-gray
underway, or an embedded doctor forward deployed han-
dling shock and trauma patients. What ever the case may be,
putting family first and improving the health of those they
serve will continue to be their mission.^
-Story by Douglas H. Stutz, Naval Hospital Bremerton,
Navy Environmental Health Center
Unveils Entomology Center of Excel-
he Navy Environmental Health Center (NEHC) un-
veiled its newest" field activity recently in Jacksonville,
NEHC, in cooperation with the Office of the Secretary of
Defense for Installations and the Environment, transitioned
the previous Disease Vector Ecology and Control Center in
Jacksonville to become the Navy Entomology Center of Ex-
cellence (NECE) for the development of new chemistries and
application technology tools to better protect deployed forces
from insect-borne diseases.
A brand new insectary located in Gainesville, FL, provided
the backdrop for the unveiling and will serve as the nerve-
center for the vast majority of NECE's research into control
of disease-borne insects.
Congressman Cliff Stearns (R-FL) and Dr. Gale Buchan-
an, the Under Secretary of Agriculture (Research, Education
& Economics) were among many dignitaries on hand for the
ribbon-cutting ceremony. Keynote remarks were given by
CAPT Gary Breeden, MSC, USN (Ret.).
"The opening of this building is a lasting symbol for the
reinvigo ration of the past successful cooperative research
between these two departments," Breeden, Program Manager
of Medical Entomology said. "All current break-through
discoveries for control of disease-carrying insects, used world-
we can begin
Congressman Cliff Stearns (R-FL) and Dr. Gale this b , uild '
Buchanan the Under Secretary of Agriculture (Re- m & tne
search, Education & Economics) cut the ribbon
opening the doors of DON'S newest insectary. Photo
courtesy of Roberto Pereira - USDA
largest of its kind in
such as malaria and
leishmaniasis, are on the
increase worldwide and
more of a threat to de-
ployed forces today than
they were 20 years ago.
Current products and
are decades old and not
suited for the high-heat
desert environments and
insects encountered in
the Middle East. New
products are sorely
needed to ensure mili-
tary readiness and global
Through NECE, the
Navy has been working collaboratively with the U.S. De-
partment of Agriculture to better understand the threat and
subsequently develop new and improved products to combat
For more information on the Navy Environmental
Health Center and the Navy Entomology Center of Excel-
lence, visit their website at http://www-nehc.med.navy.
mil/main. htm. $
-Story by Hugh Cox, Navy Environmental Health Center
Public Affairs, Portsmouth, VA.
Dr. Gale Buchanan the Under Secretary
of Agriculture (Research, Education &
Economics) examines mosquito attrac-
tion test during a tour of the insectary.
Photo courtesy of Roberto Pereira - USDA.
Read any good books lately?
Navy Medicine is looking for book reviews. If you've
read a good book dealing with military (Navy) medicine
and would like to write a review, the guidelines are:
•Book reviews should be 600 words or less.
•Introductory paragraph must contain this informa-
tion: Book name by author. Publisher, city, state. Year
published. Number of pages.
•Reviewer ID: sample:
CAPT XYZ is Head of Internal Medicine at Naval
Medical Center San Diego.
Send submission for consideration to Janice Marie
Hores, Managing Editor, at:
I look forward to hearing from you.
DOD and VA Announce Plans for
Joint In-Patient Electronic Record
The Department of Defense (DOD) and the Department
of Veterans Affairs (VA) announced plans for the joint
acquisition and use of a new common in-patient electronic
health record system. The two departments now have sepa-
rate systems that require upgrade.
Dr. William Winkenwerder Jr., Assistant Secretary of De-
fense for Health Affairs, said, "I am very excited by the pros-
pect of adopting a common, mutually beneficial solution to
our in-patient health documentation needs. This collabora-
tion is a further extension of the highly successful partnership
we have established with the Department of Veterans Affairs,
and is another example of the commitment our departments
have made to work hand in hand to provide continuity of
care for our beneficiaries."
Both VA and DOD have been independently working
on the enhancement and improvement of their respective
inpatient electronic health record tools. AHLTA, DOD's
electronic health record (EHR) is implemented worldwide
and currently supports the documentation and management
of outpatient healthcare for nearly 9 million beneficiaries.
Management of inpatient care is a future capability planned
for AHLTA. The VA is planning to modernize VistA, its elec-
tronic health record, including its inpatient module. Com-
mon need and the potential benefits led the two departments
to discuss the feasibility of jointly implementing a common
inpatient electronic health record.
Despite obvious differences in mission, such as DOD's re-
quirements to support its combat theaters, pediatric and ob-
stetrical patients, and VA's requirements to support domicili-
ary care, both agencies believe that the similarities in clinical
and business processes may make the adoption of a common
inpatient EHR a viable option.
Jim Nicholson, Secretary of Veterans affairs, who an-
nounced plans for the joint venture at a meeting of the
American Health Information Community, called the agree-
ment "groundbreaking" and said "it has the potential to fur-
ther transform the way we care for our nation's veterans and
active duty service members."
DOD and VA have made tremendous progress in their
ability to share electronic health information as they move
toward achieving interoperable electronic health records.
Millions of records and data messages are already regularly
transferred electronically between the two organizations. The
success of their efforts has placed them at the forefront of the
national effort to share health information.
Adopting a joint electronic solution for the documen-
tation of in-patient health information will facilitate the
seamless transition of active duty service members to veteran
status. It will also make the inpatient healthcare data on
shared beneficiaries immediately accessible to both DOD
and VA healthcare providers. An added benefit of adopting
a common tool is the potential for both agencies to realize
significant cost savings through a joint development or acqui-
Both agencies have agreed to conduct a study to examine
their respective clinical processes and requirements and assess
the benefits and the impacts on each department's timelines
and costs prior to a final decision on a joint acquisition strat-
egy for an inpatient EHR. <f
-U.S. Department of Defense, Office of the Assistant
Secretary of Defense Public Affairs,
NAVMED MPT&E Supports Council on
Occupational Education Conference
Navy Medicine Manpower, Training and Education
Command (NAVMED MPT&E) was represented by
the command's supervisory instructional specialist during a
joint panel discussion at the Council on Occupational Edu-
cation (COE) conference in Atlanta, GA, November 2006.
Dr. Laurel Myers, Supervisory Instructional Systems Spe-
cialist, NAVMED MPT&E, joined representatives from the
Army Management Staff College and the Defense Acquisi-
tion University to help participating DOD professional and
technical schools ease the process of the COE self-study and
accreditation visit. The self-study and accreditation visit is a
program designed to help DOD schools prepare for academic
"The COE is the national education accrediting agency
the armed forces work with to, in part, help service members
be more competitive for jobs when they leave the military,"
said Myers. "If a sailor graduates from an accredited military
school and the school uses an additional accrediting body
which assigns recommended credits by course, then the sailor
can apply for those credits to go toward a college degree,"
she stated. "Skills leaned in the Navy course can also give the
sailor a competitive edge in the job market over others who
have not been trained by a school accredited by the COE."
DOD requires all schools, including those under
NAVMED MPT&E, to meet the standards of external ac-
creditation. Myers said the message shared with the DOD
schools at the COE conference was that schools do not need
to go through the self-study in a vacuum. Help is available.
"The information we presented not only allows schools
to be armed with background information to help them
plan their self-study, but it also provides a helpful website for
schools with little or no experience," said Myers.
The self-study and accreditation survey website is available
for schools to use to share lessons learned to help each other
through the sometimes difficult process, she said. The COE
web address is www.council.org.
After the conference, Myers stated that the comments
received from COE conference participants indicated the
information on the website has been very helpful. "In fact,
a conference representative mentioned that she posted her
entire self-study on the website so that it can be used by oth-
ers as a guide in the creation of their own self-study report,"
According to Myers, the coordination of lessons learned
will benefit schools across DOD and allow for strong color-
ations across organizations to meet the requirements of the
COE self-study and accreditation visits. This process also
brought the NAVMED MPT&E name to the forefront as a
partner in guiding schools to the information sources that are
available to help them through their COE self-studies.^
— Navy Medicine Manpower, Training and Education
Command Public Affairs and Navy Medicine Support Command
Task Force on Future of Military
Deputy Defense Secretary Gordon England announced
the names of the 1 4-member future military health-
care task force. The task force will evaluate and recommend
alternatives to insure the availability and affordability of
military medicine over the long term.
As directed by Congress in the National Defense Au-
thorization Act for 2007, the task force will include seven
members from within the department and seven experts from
a variety of disciplines external to the department. Task force
members are identified in the next column.
"The military health program has many important chal-
lenges, the most critical being the rapidly growing costs of
health benefit coverage," said England, "and the need to
make adjustments so this great program can continue far into
the future. We in the department and in the Congress look
forward to the task force's recommendations."
The task force has a slate of objectives that includes assess-
ment and recommendations on wellness initiatives, education
programs, accurate cost accounting, universal enrollment,
system command and control, procurement adequacy, mili-
tary and civilian personnel mix, Medicare-eligible beneficiary
needs, efficient and cost-effective contracts, and the ben-
eficiary-government cost share structure to sustain military
health benefits over the long term. This cost sharing structure
has significant priority in that the task force must report on
this element in both the interim and the final reports.
Vice Chairman of the Joint Chiefs of Staff ADM Edmund
Giambastiani Jr. stated, "Military medicine is unmatched
anywhere in the world. Our troops know they have the best
care should they need it, and they know their families at
home have the same great care. As the leaders of this depart-
ment, we have the responsibility to ensure this excellent
healthcare continues for future generations of soldiers, sailors,
Marines, and airmen and their families."
Task force membership resulted from considered coordi-
nation with the secretaries of the military services and inter-
agency leaders. The defense secretary will receive the interim
report of the task force in May 2007, and the final report in
December 2007. Following review by the secretary, the report
will go to the Armed Services Committees of the Senate and
the House of Representatives.
"The task force represents a broad group of individuals
with outstanding expertise and knowledge of healthcare gen-
erally and also of military healthcare,"said William Winken-
werder Jr., Assistant Secretary of Defense for Health Affairs.
"The group is bipartisan and includes recognized experts in
quality, health benefit design, costs and actuarial projections,
women's health, organization and delivery of healthcare,
and national health policy. This is an impressive group of
thoughtful and experienced people who care about military
healthcare. We look forward to supporting their efforts, and I
welcome their recommendations."
Task Force Members
Department of Defense Members:
Air Force GEN John D. W. Corley, vice chief of staff,
Headquarters U.S. Air Force
Retired Army MGEN Nancy Adams, former commander
Tripler Army Medical Center and acting director, TRICARE
Regional Office, North
Navy RADM John Mateczun, Deputy Surgeon General
Air Force LGEN James Roudebush, Surgeon General
Air Force MGEN Joseph Kelley, deputy director of logis-
tics for medical readiness, the Joint Staff
Shay Assad, director of defense procurement and acquisi-
tion policy, Office of the Undersecretary for Acquisition,
Technology and Logistics
Retired Air Force GEN Richard B. Myers, former Chair-
man of the Joint Chiefs of Staff
Non Departmental Members:
Robert J. Henke, Assistant Secretary for Management,
Department of Veterans Affairs
Dr. Carolyn Clancy, Director of the Agency for Health-
care Research and Quality, Department of Health and Hu-
Gail R. Wilensky, Ph.D., elected member of the Institute
of Medicine of the National Academies and its governing
Robert F. Hale, senior fellow at the Logistics Manage-
ment Institute and member of the Defense Business Board;
formerly Assistant Secretary of the Air Force for Financial
Management and Comptroller
Army Reserve MGEN Robert Smith, past president and
current member of the Board of the Reserve Officers Associa-
tion, and global controller, Vehicle Service & Programs, Ford
Larry Lewin, founder of The Lewin Group and currently
executive consultant on clinical and technology effectiveness,
Dr. Robert Galvin, director of global healthcare for Gen-
Patient Care System Aims to Reduce
The Departmen of Defense has trained thousands of
military healthcare providers to employ a quality man-
agement system that's designed to minimize human errors
in hospital operating and delivery rooms, a senior defense
The Team Strategies and Tools to Enhance Performance
and Patient Safety (TeamSTEPPS) program stresses team-
work and communication among doctors, nurses, and other
healthcare providers to improve quality, safety, and efficiency
across military healthcare, Dr. David N. Tornberg, Deputy
Assistant Secretary of Defense for Clinical and Program
Policy, said during an interview with the Pentagon Channel
and American Forces Press Service.
"Providing the optimum, cutting-edge care to our ben-
eficiaries is what this is all about," he said. "I'm proud to say
that the Department of Defense and the military healthcare
system are absolute leaders in enhancing a culture of safety in
our military treatment facilities."
Use of TeamSTEPPS creates "an environment where
people broadly communicate and have a clear understanding
of the goals and objectives of the team," Tornberg contin-
ued. "Establishing a culture of patient-centered care through
the use of teamwork and enhanced communication among
healthcare employees is absolutely vital. Miscommunication
clearly is associated with medical errors."
More than 5,000 healthcare givers at more than 80 mili-
tary treatment facilities in the continental U.S. have received
TeamSTEPPS instruction in the last 3 years. And now, about
1,000 trainers and coaches are teaching the concept at other
military hospitals and clinics. The program has been 'incred-
ibly well-received' by military healthcare givers, Tornberg
"The training system was developed from more than 20
years of experience in the aviation, military, nuclear power,
healthcare, business, and other safety-conscious industries,"
DOD is now collaborating with the U.S. Department of
Health and Human Services' Agency for Healthcare Research
and Quality to make TeamSTEPPS available to the public
health care industry."
The military health system operates 72 hospitals and
more than 500 medical and dental clinics administering
care to more than 9.3 million beneficiaries, according to
-Story by Gerry J. Gilmore, American Forces Press Service,
On 19 September 1950, a Douglas R5D "Skymaster" en route to
Japan crashed at Kwajelein, Marshall Islands. On board were
26 Navy officers, including 11 Navy nurses — all of whom lost
their lives in the accident. The tragedy marked the largest loss
of nurses in history. A memorial to the victims was unveiled on
Kwajelein in mid-February.
Okinawa, Japan. VADM Donald C. Arthur, far right, and Com-
manding General III Marine Expeditionary Force, LTGEN Joseph
F. Weber, far left, join Naval Hospital Okinawa Commanding of-
ficer CAPT Peter F. O'Connor, and LCDR David W. Hardy, head
of pharmacy services, for a ribbon cutting to commemorate
the official opening of the newly remodeled pharmacy at U.S.
Naval Hospital Okinawa. The new state-of-the-art facility is the
result of a $4.1 million dollar renovation project to expand and
upgrade pharmacy operations at the hospital. November 2006.
Photo by Brian J. Davis
Risk Communication Training
to Be Featured at
Navy Occupational Health and Preventive Medicine Conference
Risk Communication training will be featured at the 46th Navy Occupational Health and Preventive Medicine
Conference, held at the Hampton Roads Convention Center, Hampton VA, from 17-22 March 2007.
Originally intended to provide environmental health professionals with the tools necessary for communicating envi-
ronmental and occupational health risks to Navy and Marine Corps personnel and the general public, Risk Communi-
cation has begun to partner with the Public Affairs community to further enhance its ability to "deliver the message" to
The Risk Communication training intended for both environmental health and military public affairs professionals
will be held March 2 1 st and 22nd. RADM Smith, Chief of Naval Information, is scheduled to deliver the keynote ad-
dress for the Risk Communication track. Environmental Health and Risk Communication subject matter experts from
Army and Navy as well as Mr. Guy Schein, Public Affairs Officer for Navy medicine are among the scheduled guest
speakers offering attendees an interactive and multi-disciplinary approach to Risk Communication.
For more information on the Navy Occupational Health and Preventive Medicine Conference, visit the Navy Envi-
ronmental Health Center website: http://www-nehc.med.navy.mil/Conference07/Index.htm
In order to participate, attendees must create an account online and register for the Risk Communication Case
Champions of Operational Readiness
The Naval Operational Medi-
cine Institute (NOMI) is a
subordinate command of the Navy
Medicine Manpower Personnel
Training and Education Com-
mand. NOMI functions as one of
the Navy's most dynamic com-
mands with a mission of providing
a tactically proficient, combat cred-
ible naval medical force providing optimal force health pro-
tection to support the joint war fighter at any time and any
place, along the full spectrum of operations. With training
components geographically dispersed across the country,
NOMI supports the largest training throughput in Navy
medicine with roughly 25,000 students trained annually. As
stated by NOMI's CO, CAPT Barney R. Barendse, "NOMI
supports the joint war fighter through employment of
state-of-the-art resources, medical knowledge, and research
in order to provide exceptional educational and training
as the foundation for Force Health Protection." NOMI is
recognized as the proven expert in aviation survival train-
ing, undersea medicine, surface warfare medicine, aerospace
medical physical standards, aerospace medical disposition,
aerospace education, fleet hospital operations, operational
medical lessons learned, and prisoner of war studies.
As part of the NOMI Headquarters staff located in Pen-
sacola, FL, and the only medical lessons component in Navy
medicine, the Naval Operational Medical Lessons Learned
Center (NOMLLC) mission is to collect, review, validate,
and disseminate key observations, insights, and lessons
involving medical support. NOMI has been designated by
the Chief of Naval Operations (CNO) as a Warfare Center
of Excellence. In this capacity, NOMLLC collects and dis-
seminates information by identifying significant issues and
providing feedback to all operational medical activities to
improve Navy medicine readiness in support of the joint
war fighter, situational awareness, and health service support
readiness. Lessons learned submitted via active collection,
passive collection, or direct reporting from medical support
of operational missions are systematically captured and in-
tegrated into concept development to generate new tactics,
techniques, procedures, and doctrine. Lessons learned will
also serve as principal sources for the design of future Navy
medical education and training curricula, courseware, train-
ing events, and execution of medical operational support of
the war fighter. Captured observations, after action reports,
and lessons learned can be input through both Non-secure
Internet Protocol Router Network (NIPRNET) and Secret
Internet Protocol Router Network (SIPRNET) websites with
the objective of sharing knowledge to highlight both positive
and negative experiences and to provide change agents input
for resolution to identify gaps.
The Robert E. Mitchell Center for Prisoner of War Stud-
ies is also part of the NOMI. The Mitchell Center evaluates
former prisoners of war from all services, as well as their
experiences both in captivity and through repatriation and
reintegration into society, so that these lessons learned may
be used to help others in future conflicts. The goals of the
Center were originally established by CAPT Robert E.
Mitchell, a Navy flight surgeon, and continue today as a re-
sult of congressional funding that led to establishment of the
Center with ongoing support.
Formerly known as the Fleet Hospital Operations and
Training Center (FHOTC), the Naval Expeditionary Medical
Training Institute (NEMTI) is located aboard Marine Corps
Air Station Camp Pendleton, CA, and is evolving into the
Center of Excellence for the training of Navy deployable,
shore-based healthcare facilities. NEMTI provides all field
training on the assembly, disassembly, establishment of com-
mand structure, and basic operations of a Navy Fleet Hospi-
tal to personnel assigned to fleet hospital billets. NEMTI also
provides and hosts "theater specific" training for personnel
currently deploying in support of Navy Fleet Hospitals and
Expeditionary Medical Facilities and serves as the Navy's field
test and evaluation center for deployable medical systems
equipment and doctrine.
The Naval Survival Training Institute (NSTI) was es-
tablished on 1 October 2002, and includes a headquarters
element located at Naval Air Station Pensacola, FL, and eight
Aviation Survival Training Centers geographically dispersed
across the country. The primary mission of the NSTI is to
provide safe, effective, fleet relevant aviation survival and hu-
man performance training in order to meet CNO operational
training requirements. NSTI is responsible for the develop-
ment of Naval Aviation Survival Training Program (NASTP)
curricula, training standardization, and safety, and also vali-
dates new and modified survival equipment configurations.
It also establishes training and egress procedures for Naval
Air Systems Command and other joint organizations. NSTI
provides high-risk aviation survival training to approximately
23,000 personnel annually.
The Naval Aerospace Medical Institute (NAMI), located
in Pensacola, FL, is the world leader in aerospace medi-
cal qualification and education, with a mission to provide
professional and technical support, aeromedical disposi-
tion, and consultative services in operationally related
naval medical matters worldwide. Education and training
programs for medical department personnel in various op-
erational medical disciplines including aerospace medicine,
flight surgery, aerospace physiology, aerospace experimen-
tal psychology, aviation optometry, and aerospace medical
technicians are provided to over 200 joint and international
students annually. NAMI is accredited by the Accredita-
tion Council on Graduate Medical Education as a BUMED
Located at Naval Submarine Base Groton, CT, the Naval
Undersea Medical Institute (NUMI) provides training and
technical support in undersea medicine, radiation health, and
related matters, to meet the requirements of Navy medicine
and to provide technical support in those matters to naval
operating forces worldwide. NUMI provides training for sub-
marine independent duty corpsmen, radiation health techni-
cians, undersea medical officer candidates, and radiation
health officers. NUMI also provides the Navy's only Radia-
tion Health Indoctrination Course for officers and enlisted
personnel ordered to a wide variety of billets throughout the
fleet. Staff members field calls from military activities all over
the world on matters related to radiation health, undersea
medicine, and submarine medical administration.
Located in San Diego, CA, the Surface Warfare Medicine
Institute (SWMI) supports operational medical readiness
for the surface forces through training, consultation, and re-
source publication. Courses include Commander, Amphibi-
ous Task Force—Surgeon Course (CATF-S), Surface Warfare
Medical Officer Indoctrination Course (SWMOIC), Surface
Warfare Medical Department Officer Indoctrination Course
(SWMDOIC), Operational Medicine Symposia (OPMED),
and Medical Augmentation Program Training (M+ 1 Train-
ing) for Casualty Receiving and Treatment Ship Augmenta-
The Naval Special Operations Medical Institute
(NSOMI), located at Fort Bragg, NC, was established on
1 October 2006, and is the sole source of medical training
for Special Operations Forces (SOF) medics, technicians,
and corpsmen under U.S. Special Operations Command
(USSOCOM). NSOMI is the Navy Detachment within
the Army Joint Special Operations Medical Training Center
(JSOMTC) and offers training courses in Special Opera-
tions Combat Medic, Special Operations Independent Duty
Corpsman, and Special Operations Combat Medical Skills
NOMI is a unique command providing operational
medicine education and training, consultative services, and
aviation survival training in direct support of the joint war
fighter in all warfare disciplines. Truly a force enabler, NOMI
is manned by proud professionals that continue to ensure the
sustainment of a fit and healthy force in order to aggressively
prosecute the Global War on Terrorism and achieve all De-
partment of Defense objectives.
To learn more about NOMI and its training components
visit their command website at http://www.nomi.med.navy
mil/index. htm. To register on the Naval Operational Medi-
cal Lessons Learned Center website go to https://www.mccU.
Nurse Corps Communication Team
Gets the News Out
With a community that stretches itself across the globe,
the Navy Nurse Corps (NC) is continuously work-
ing to create new and improved ways to share information
in a timely and efficient manner with its members. The NC
Communication Team was established in the fall of 2006 for
"RDML Christine Bruzek-Kohler, Director, NC, met
with senior leaders back in August 2006 to establish the
priorities of the corps. Communication was a major topic of
this meeting. Senior leadership was concerned that official,
efficient, and timely information was not being shared within
the community and they wanted to rectify this situation.
From this meeting the NC Communication Team was born,"
said LCDR Newton Chalker, Corps Chiefs Action Officer.
The team is comprised of 24 members. These members
are responsible for six cornerstone products: NC admiral's
regional senior nurse executives' call (every 2 months), Ad-
miral's all NC community VTC (every 6 months), NC news
live, newsletter (weekly), web homepage, and email groups.
According to Chalker, every 6 months the Director will
hold a video teleconference (VTC) all hands call. This will
provide corps members the opportunity not only to see and
hear the key messages the admiral wishes to share, but also al-
lows time for a question and answer session. For those mem-
bers who are unable to attend the VTC, the meeting will be
recorded for rebroadcast on the NC web homepage. The next
VTC is scheduled for March 2007.
The NC web homepage (https://wwwa.nko.navy.mil/por-
tal/splash/index.jsp) has been in existence for some time. As
with any product, the NC felt it was time for a change in the
website. "With the idea of providing up-to-date and useful
information, we took a deeper invested interest in how our
website not only looked, but also in how we are going to
present that information to our community and to the pub-
lic," said Chalker.
He continued, "Ownership of information is key in pro-
viding the most useful information for that particular com-
munity. The corps has several communities within the overall
community and we found that when a specific community,
say Reservists, has ownership of their web page, they take
pride in it. They want to put their best foot forward and
provide the type of information to their community that will
be of most use. Also, each web page provides a point of con-
tact information to the community. If you have a question or
comment about a particular community web page, you have
access to a person who can assist you."
One of the more innovative creations of the communi-
cation team is the NC News Live web cast. "This is a live,
dial-in show that allows our members to call in, ask questions
and discuss topics of interest," said Chalker. "The show is
broadcast on the NC website and has been a huge success.
Our next show is scheduled for 1 5 January and will be both
audio and video. We record each show and provide a link to
the recording just in case someone misses the live show, but
won't miss out on the information."
For community members who prefer a paper information
format, the NC newsletter will suit your taste. "In this day of
technological advances, people still like to have printed mate-
rials to receive information," said Chalker. "This is where the
NC newsletter comes in. The newsletter is published every
week and is available online at the website for members to
download and print. Only official NC news and information
is printed in the newsletter. Along with that information we
also provide a section to highlight the good things individual
folks are doing, our Bravo Zulus."
The information provided by the communication team is
available to all members of the community — officers, hospi-
tal corpsmen, and civilian and contractor personnel.
For more information about the NC Communication
Team and its products, contact LCDR Chalker at njchalker@
-From Bureau of Medicine and Surgery Public Affairs,
Fleet Surgical Team 5 performs laparoscopic surgery aboard the
amphibious assault ship USS Boxer (LHD-4) while on station in
the Persian Gulf. Photo by MC Paul Polach, USN
SimMan Joins Amphib Fleet to
Revolutionize Medical Training
Expeditionary Strike Group 5 (ESG) recently introduced
a Simulated Man, or SimMan, a revolutionary training
mannequin for use in casualty training scenarios. Accord-
ing to CDR Michael A. Nace, Deputy Group Surgeon for
Commander Amphibious Group (CPG) 3, the SimMan is a
major step forward in preparing deck plate sailors and medi-
cal personnel alike in emergency life saving procedures. "It
can be used to train, educate, and reinforce the capabilities
of the entire medical department," said Nace.
According to the manufacturer, SimMan's natural phy-
sique, simulated vital signs, and internal body sounds com-
bine with functionality to make this advanced patient simula-
tor ideal for training on everything from intravenous (IV)
needle insertion to realistic practice of chest tube insertions.
The ultimate goal of SimMan is improving medical train-
ing and response to casualties across the ESG, from top to
bottom. "Everyone from the basic stretcher bearer to the
surgeons can benefit," Nace said.
LT Rhonda Bennett, Fleet Surgical Team (FST) 9 s critical
care nurse, said SimMan's humanlike features allow trainers
and trainees alike to practice IV injections in the replace-
able IV training arm, take vital signs on a simulated pulse
at multiple points on the body, and simulate clearing the
mannequin's realistic airway. "The lifelike features make the
in-theory part of training virtually disappear," said Bennett.
"SimMan is so realistic it is almost like training on a real
person. We no longer have to train in theory or on lifeless
mannequins. This is real life hands-on training." According
to Bennett, the multi-faceted capabilities of SimMan create
a training environment far more advanced than what was
available on previous training mannequins. "This is an excit-
ing new way to train," she said. Bennett recently completed
a SimMan training program in Sarasota, FL. "We can now
train in real life scenarios that will better equip every sailor to
be first responders to medical emergencies."
The ultimate goal for Nace, the ESG and the fleet is for
SimMan to increase medical readiness across the waterfront.
"The technological advances have made this level of training
available to all hands and will be available for a variety of
training environments," he pointed out.
"The training possibilities are unlike anything we have
seen in previous training mannequins," said Nace. SimMan
provides realistic training feedback previously unavailable on
earlier model training aids.
HM2(SW) Nathan Hagman, a bio medical technician
aboard USS Bonhomme Richard (LHD-6) (BHR) which re-
cently acquired SimMan, said the integrated computer system
continually monitors the treatment conducted on SimMan
and generates multiple real time and after action reports.
The SimMan computerized training mannequin is current-
ly in use across the military and has been integrated into the
training curriculum at hospital corpsman "A" school at Navy
Hospital Corpsman School, Great Lakes. The BHR medical
staff expects to provide training utilizing this revolutionary de-
vice to ships across the ESG starting early next year.</
-Story by MC2 Dustin Mapson, USS Bonhomme Richard
(LHD-6) Public Affairs.
COL David Schall, European Command (EUCOM) Surgeon General, hosted a quarterly Component Surgeons
conference at the Navy Europe (NAVEUR) Surgeon's headquarters in December. The conference brought together
the senior medical advisors in the European theater (l-r: COL Mark Ediger, USAFE Surgeon General; COL Corne-
lius Maher, USAEUR Deputy Surgeon General; COL David Schall, EUCOM Surgeon General; CAPT Alton Stocks,
CNE-Force Surgeon) to discuss issues such as, Avian Flu Influenza plans, medical support to Africa Command
(AFRICOM), and updates on current EUCOM theater security plans. Photo by mci(aw) Nathan l. Guimont , usn
Japanese Doctors Tour USS Essex
USS Essex (LHD-2) hosted 18 Japanese doctors from the
Sasebo community 23 December to demonstrate the
ship's medical capabilities as well as its ability to provide air
and sea support used during disaster relief operations. Ac-
cording to LT Scott Margraf of the Sasebo Branch Medical
Clinic, sharing knowledge and capabilities will give confi-
dence to the doctors in Sasebo if a disaster were to hit Japan.
Essex played a key role in disaster relief after a tsunami hit
Indonesia in 2004.
"If there is ever a disaster in the Sasebo area, we would
need to pool our resources. It's imperative to know ahead
what medical capabilities each other has," said Margraf.
CDR Brett V. Sortor, Essex senior medical officer, also
emphasized the importance of joint cooperation between
the Navy and the Sasebo community. "We rely on Japanese
healthcare to take care of patients in their hospitals," said
While Essex's primary mission is to conduct prompt
and sustained combat operations at sea, its secondary
mission is to serve as a hospital during humanitarian mis-
sions and disaster relief. Essex has more than 320 beds for
patients, a 14-bed intensive care unit, and two operat-
ing rooms. "With all our capabilities, Essex is like a small
community hospital. It's amazing when people see we have
more capabilities than most hospitals of comparable size,"
"The intensive care unit (ICU) and operating rooms were
really interesting to me," said Sadahiro Asai, a Japanese pul-
monologist at SoGo Hospital in Sasebo. "I really appreciate
SASEBO, Japan (December 2006) - CDR Brett V. Sortor, SMO for
USS Essex (LHD-2), explains the medical facilities during a tour
for doctors from local area hospitals. Sasebo, Japan. Photo by mc
Michael A. Lantron, USN
and am thankful for the opportunity to come onboard and
tour the ship."
The relationship between Essex and its surrounding com-
munity is a vital part of military operations. This visit aboard
Essex was another step in the ongoing process of integrat-
ing U.S. Navy assets into the Sasebo community. "There is
a Japanese word, nemawashii, which means 'root binding',"
said Margraf, describing the cultural process of gaining ap-
proval for decisions before the decision-makers complete the
decision. "In order to work together, we must have visits like
this where we learn nemawashii."
Essex is part of the flagship Essex Expeditionary Strike
Group (ESXESG), operating out of Sasebo, Japan; which
serves under Commander, Expeditionary Strike Group
(ESG) 7/Task Force (CTF) 76, the Navy's only forward-de-
ployed amphibious force. Task Force 76 is headquartered at
White Beach Naval Facility, Okinawa, Japan, with an operat-
ing detachment in Sasebo, Japan. <f
-Story by MC Michael Lantron, USS Essex Public Affairs,
Camp Pendleton Medical Battalion
Provides Care to Military and Civilian
Charlie Health Services Company Al Asad detachment,
1 st Medical Battalion Camp Pendleton, CA, of Com-
bat Logistics Regiment 15, has operated on more than 200
patients and completed more than 400 Level II resuscita-
tions from August to December 2006 in support of Opera-
tion Iraqi Freedom.
According to CDR Richard Sharpe, detachment officer-
in-charge, the company's mission is to provide Level II care,
which is the first echelon of care that surgical resuscitation
can be performed. "We take care of everyone that is brought
to us, which includes US Armed Forces, Coalition forces,
Iraqi Security Forces — mainly Iraqi Army and Iraqi Po-
lice — Iraqi civilian men, women and children, and detainees;
whoever is brought to us, we treat," Sharpe said.
"The patients are from Level I facilities, which are battal-
ion aid stations, shock trauma platoons, or directly from the
battlefield to here," he added.
Like doctors, Navy nurses and corpsmen take a solemn
pledge to treat all injured, regardless of nationality, treating
"It's not a struggle to treat everybody equally, but there is
something there that you feel and see, knowing that if this
detainee was awake right now he could try to hurt you, but
you're trying to protect him," said LT Alecia Gende, an in-
route care nurse. "You're risking your life and all the crew on
HM3 Aloen Delapena applies clean bandages to a wound on the
face Of an Iraqi Citizen. Al Asad, Iraq. Photo by MC Kenneth R. Hendrix,
that helo to take this guy who is trying to kill us to the next
level of care so we can prevent him from dying," Gende said.
The corpsmen function a lot more independently here
and for junior corpsmen like HM(FMF) Rene Acerosala-
zar who is grateful for the training he receives and the
experience. "I didn't like doing stitches at first because it's
intimidating with the patient looking at you and I would get
nervous," Acerosalazar said. "But the nurses and experienced
corpsmen let me know the patient doesn't feel anything and
not to worry. It's good to know they're here for me."
First- time deployed HMl(FMF) Brandi Collins, who has
previously served as a histology technician and independent
duty corpsman, shared one of her profound moments in the
emergency trauma room. "We had a gentleman that we had
to start cardiovascular pulmonary resuscitation (CPR) right
as he got off the helo because he was crashing. It was the
first time I performed CPR since graduating from school. I
jumped on top of the gurney, started CPR, and rode in with
him from the helo pad to operating room," Collins said.
The battalion has a full-time interpreter on staff to help
communicate with the Iraqi citizens. "The interactions we
have with the Iraqi patients is very positive," said Sharpe.
"They appreciate the fact that we are here to take care of
them, no matter who they are."<^
-Story by MC Kenneth R. Hendrix, Navy Expeditionary
Logistics Support Group Public Affairs, AlAsad, Iraq.
Navy's Leadership "Dock" at TQ
The United States Navy's top sailors visited Camp Taqad-
dum 23 December. ADM Michael G. Mullen, Chief
of Naval Operations, and MCPO Joe R. Campa Jr., Master
Chief Petty Officer of the Navy, visited to speak with sailors
and Marines on base.
The visit was part of a tour through Al Anbar Province
where Mullen and Campa met and greeted sailors fighting
in support of Operation Iraqi Freedom, which according to
the service members featured, was a morale booster. "It was a
great experience to be able to meet the Chief of Naval Opera-
tions," said HN Tiffany N. Reese, with Surgical and Shock
Trauma Platoon, Taqaddum Surgical, 1 st Marine Logistics
Group (Forward). "Knowing the position that he holds, and
that he still comes out and sees the troops, is very rewarding."
During the visit, hospital personnel gave Mullen a tour
of Taqaddum Surgical, where the leaders met sailors and
Marines. While Mullen toured TQ Surgical, Campa met
with the senior enlisted — chief petty officer and above — and
requested the sailors to continue focusing their efforts on
"Deck-plate" leadership, according to Campa, is a method
for sailors to replace the idea of "command and control" with
"commitment and cohesion." After the meetings, Mullen
and Campa shared lunch with several sailors and Marines,
and listened to comments from the troops about their experi-
ences in Iraq.
After lunch, an open-forum meeting was held at the
main-side chapel to give opportunity for any sailor to ask the
CNO or the MCPON what was on their mind. The leaders
answered questions ranging from subjects like the increase
of troops in Iraq to improving education for sailors on active
duty and reserve.
"The focus is always on the Marines and sailors," said
Mullen. "I thank you for your service and I am grateful to be
here and in uniform with you."
Mullen and Campa told the sailors and Marines "not a
day goes by where they don't think about them."^
-Story by CPL Ryan L. Tomlinson, 1st Marine Logistics
Group, Camp Taqaddum, Iraq.
ADM Michael G. Mullen watches doctors performing surgery at
Taqaddum Surgical during a visit to Camp Taqaddum, Iraq. Photo
by LCPL Ryan L. Tomlinson, USMC, 1st Marine Logistics Group
Philadelphia, PA. Sailors unload an injured passenger from the
cruise liner Celebrity Century onto the multipurpose amphibious
assault ship USS Wasp (LHD-1). Sailors from Wasp are trans-
porting three civilians and one Chilean sailor in need of medical
care to the nearest hospital. November 2006. Photo by mci Jeremy
Pacific Ocean. HM1 Anthony Naul cleans
the teeth of a sailor aboard USS John C.
Stennis (CVN-74). January 2007. Photo by
MC John Wagner, USN
World Class Care , . .Anytime, Anywhere
Yokosuka, Japan. LT Brian Rounds and HM Manouchka
Eugene perform a routine cleaning at Fleet Dental at Yo-
kosuka. January 2007. Photo by MC Kari R. Bergman, USN
Atlantic Ocean. Surgical technician, HM1 Queena Nash, left,
passes a pair of hemostats to the ship's surgeon, CDR Stanley
Napierkowski, during surgery to repair a sailor's inguinal hernia
in the operating room on board USS Harry S. Truman (CVN-75).
Truman is currently underway conducting flight deck certifica-
tions in the Atlantic Ocean. January 2007. Photo by mc3 Knstopher
Sasebo, Japan. HM1 Joseph Calderon, assigned to Naval Branch
Health Clinic Sasebo's emergency response team (ERT), goes
through a decontamination shower after a mass casualty drill
as part of Exercise Keen Edge at Fleet Activities Sasebo. Keen
Edge is a joint and bilateral command post exercise designed to
increase interoperability and readiness between U.S. and Japa-
nese forces. February 2007. Photo by MC2 Ryan McGinley, USN
Al Asad, Iraq. LCDR Thomas Friedrich, assigned to the 1st Medi-
cal Battalion, Camp Pendleton, performs a medical evaluation
on an Iraqi citizen. The 1st Medical Battalion provides level II
care, which is surgical resuscitation to U.S. Armed Forces, co-
alition forces, Iraqi security forces, and civilians in support of
the global war on terrorism. December 2006. Photo by mc Kenneth
R. Hendrix, USN
Persian Gulf. HM2 Scott Grucza examines the hand of an injured
sailor aboard amphibious assault ship USS Boxer (LHD-4). Boxer
is currently conducting Maritime Security Operations (MSO) in
Support Of 5th Fleet. January 2007. Photo by MC Joshua Martin, USN
Camp Taqaddum, Iraq. LT Ron F. Sanders, NC, with Taqaddum
Surgical's Forward Resuscitative Surgical System, evaluates an
incoming 'patient' during a mass casualty drill. January 2007.
Photo by LCPL Geoffrey P. Ingersoll, USMC
Sasebo, Japan. HMCS Michael Bowe-Rahming prepares
for a training dive aboard the rescue and salvage ship USS
Safeguard (ARS-50) during at-anchor dive operations off
the coast of its forward-deployed home of Sasebo, Japan.
January 2007. Photo by MC Kyle Carlstrom, USN
Naval Hospital Bremerton. Stairchair: Staff members at Naval
Hospital Bremerton carry one of their own on the hospital's
new stair chairs during emergency patient evacuation training.
Emergency evacuation was just one aspect of the hospital's
earthquake preparedness training drill. Photo by mci(sw) Fletcher
Doctors, Corpsmen Practice Hand-
When they're not combating patients' injuries, a few
doctors and corpsmen at Taqaddum Surgical are
learning hand-to-hand combat, Marine Corps style.
Sailors recently attended Marine Corps Martial Arts Pro-
gram (MCMAP) classes a few hours every day for approxi-
mately 2 weeks. And though they all walked a little taller
wearing their Marine Corps tan belts, for some of the sailors,
their new sense of pride wasn't only located around their
"MCMAP has an effect that transcends well beyond the
physical activity," said CAPT Michael A. Thompson, officer-
in-charge of TQ Surgical, 1st Marine Logistics Group (For-
ward). "It's a team building exercise," continued Thompson.
"It teaches leadership, cohesiveness, and unit integrity. And,
plus, it's fun."
"How often do you get to put your boss in a headlock,"
said LCDR Pamela C. Harvey, MC. Harvey laughed after
recollecting some MCMAP methods she had to practice on
Service members often paired up to practice their MC-
MAP regardless of rank. To the instructor, this type of bond
is just another benefit of the program.
"It builds up their camaraderie," said GSGT Eric E. Har-
ris. "It helps service members get to know each other better,
beyond rank and work. They see a totally different side of a
person," said Harris, a MCMAP black belt instructor.
"The people who took the class feel like they've accom-
plished something together," pointed out HM1 Allan D.
Felicano. "It's a good way to gain more confidence by chal-
lenging one's fortitude and endurance."
According to a few sailors, the class pushed them to their
physical limits. Some said they wouldn't have made it with-
out motivation from each other and from Harris. "He's got a
tremendous attitude," said Thompson of Harris, "He really
fulfilled and exceeded my expectations, and he integrated the
technical aspects of martial arts training but really infused
aspects of the team mentality."
Thompson recalled a time during the class when the
students were performing a conditioning exercise. He said
he had been wondering if he was capable of finishing the
exercise, when Harris leaned over him and said, "You think
you're tired, look at the guy next to you." Thompson saw that
the student beside him, a corpsman, was tired, but he was
not giving up.
"Other team members were inspiring," said Felicano, "It
got certain members through. We started together, and we
"They learned never to leave anyone behind, never quit
trying, and support each other," said Harris.
Besides a new sense of confidence and teamwork, the stu-
dents also gained an improved ability to defend themselves.
This may prove to be a useful skill for corpsmen working
closely with Marines. "When we go off base, we're not going
to have rifles," said Felicano. He said that if something goes
wrong, he feels "a little more prepared to protect patients."
If attacked, "I don't want to feel like I am a drag on the
Marines with us," said Harvey.
Wearing a MCMAP belt as a corpsman also gains Ma-
rines' attention, said Thompson. "It really earns us some
credibility," Thompson continued. "The Marines do not give
out their acceptance lightly."
Thompson also emphasized the necessity for his sailors to
learn as much about Marine culture as possible. And where
better to start, then with Marine Corps Martial Arts. "MC-
MAP gives us insight into the Marine Corps mission, and
from a medical standpoint, there is no greater honor than to
be attached to a Marine Corps unit," said Thompson. <£
-Story by LCPL Geoffrey P. Ingersoll, 1st Marine Logistics
Group, Camp Taqaddum, Iraq.
HN Lyndon S. Jagroop, a field medical technician with Taqaddum
Surgical, 1st Marine Logistics Group (Forward), practices a Ma-
rine Corps Martial Arts leg sweep. When they're not combating
patients' injuries, a few doctors and corpsmen at TQ Surgical are
learning hand-to-hand combat, Marine Corps style. Photo by lcpl
Geoffrey P. Ingersoll, USMC
Iraq's Future Stands up with Help
They called, and we answered. American forces and
Iraqi soldiers reached out in response to local civilians'
requests for medical care and school supplies during a hu-
manitarian mission. "The civil affairs piece [of our mission
in Iraq] is how we build a relationship and build trust in
their community, and also how we help the Iraqi Army and
the Iraqi infrastructure stand up on their own," said CAPT
Adam A. Gilbertson, USA.
The Iraqi Army led service members from door to door in
the town of Mujar, interacting with locals and offering aid in
any way possible. Civilians who seemed initially apprehensive
soon became friendly, offering gratitude and sometimes tea to
"With somebody carrying a rifle, [who] speaks their
language, walking up to them, and asking them questions,
[the civilians] were kind of stand-offish," said 1 st LT Sean
M. Kiesz, USA, platoon leader for Able Company, 2nd
Combined Arms Battalion of the 136th Infantry Regiment,
attached to 1st Marine Logistics Group (Forward).
"But as time went by they got a reassuring feeling and
they opened up," continued Kiesz.
"This is the first time the Iraqi Army appeared in Mujar
since 2003 when they were under Saddam's leadership," said
Gilbertson. Gilbertson said that this time the Iraqi Army's
approach was probably different. "The Iraqi Army brought
an ambulance so that we were able to bring people to the
clinic right from their homes," said Gilbertson.
In a united effort, American and Iraqi forces set up a
temporary medical-care clinic adjacent to the town's public
school. Simultaneously, Iraqi soldiers and American service
members traveled door to door, stopping to inform citizens
of the clinic as well as talk about any concerns local citizens
might have had.
"This mission gives citizens in the area exposure to the
military with something other than a combat military opera-
tion," said LTCOL Joseph T Burns. Citizens talked openly
with the Iraqi Army once they learned the purpose of mis-
sion. At one home, an Iraqi interpreter proclaimed with a
smile "Don't worry, the good guys are here!" An Iraqi man
and his wife chuckled at the interpreter, and Iraqi soldiers
scooped up their smiling children.
"It's a goodwill builder, which is certainly important in
what we're doing here," said Burns.
Along with medical attention, service members presented
the school with many boxes filled with pens, pencils, papers,
dolls, and soccer balls. Lined up in eager anticipation, the
children walked away with armfuls of supplies handed to
them directly by Iraqi soldiers.
American forces and Iraqi soldiers reached out in response to lo-
cal civilians' requests for medical care and school supplies during
a humanitarian mission. Photo by LCPL Geoffrey P. Ingersoll, USMC
"It's very important to get the Iraqi Army involved," said
SSGT Brian M. Ness. It shows the people that their soldiers
are part of their eventual independence, added Ness. Kiesz
agreed and emphasized the importance of Iraqi children to
international relations. "If we can build trust in an Iraqi kid,
then when he grows up and becomes a soldier or a town
leader, that relationship will still be there," said Kiesz.
The future was on the minds of many Americans and
Iraqis during the mission. And in the eyes of some service
members, rebuilding Iraq's educational system is as important
as rebuilding their army.
"When we educate the kids, it's better for them because in
the long run they are going to be the leaders of this country,"
said HM3 Kyle B. Whiteman. "The more educated they are,
the better the country will become," continued Whiteman.
Iraqi school officials also received a $500 check from Iraqi
Army General Behe'a Hussein Abed Hassen on behalf of
2-136. But for a few service members, no price tag could be
attached to the support and improved morale supplied by
American and Iraqi forces. "No matter what it is — security,
medical, or just someone to talk to — they know that we're
here for that . . . they can definitely move forward from this
point on," said HM1 Amber N. Floyd.
"This mission achieved the idea that the Iraqi Army is a
valuable part to freedom for this country," said Ness, "they
showed that they can make a difference in their own com-
-Story by LCPL Geoffrey P. Ingersoll, 1st Marine Logistics
Group, Camp Taqaddum, Iraq.
Navy Physician Named Recipient of
William Kane Rising Star Award For
A preventive medicine physician from Navy Environmen-
tal Health Center, currently deployed as the deputy
medical adviser for the NATO International Security Transi-
tion Force (ISAF), was honored 24 February for winning
the 2007 American College of Preventive Medicine (ACPM)
William Kane Rising Star Award.
CDR Paul D. Rockswold, MC, (UMO), is being recog-
nized for his many contributions, including his role as the
deputy command surgeon, Combined Forces Command - Af-
ghanistan, and deputy medical adviser, working with the high-
est levels of the Afghan government to help build the medical
infrastructure of the country and its security forces, including
his participation in efforts to eradicate polio on a global level.
The award presentation is scheduled to be held at the
ACPM Awards Banquet in Miami.
This highly prestigious award recognizes physicians on a
national scale for significant contributions in preventive med-
icine. According to Rockswold, this is a crowning achieve-
ment in his profession.
CDR Rockswold with Afghan children. Photo cour-
tesy of CDR Rockswold
for his work
as a physician
where he played
a key role in the
of the Navy
Health Center s
Data Center, a
state-of-the-art surveillance system for tracking and analyzing
injury and disease Navy and Marine Corps wide.
He has also been involved in the investigation of epide-
miologic concerns such as Dengue Fever, Plague, Tuberculo-
sis, Norovirus, and Guillain-Barre Syndrome.
"The time in Afghanistan has been a tremendous oppor-
tunity to provide meaningful input toward the stabilization
of a country," said Rockswold. "My perspective has grown
greatly. I believe that peace and stability will improve the
health and safety for Afghans."^
-Story by Hugh Cox, Navy Environmental Health Center
Public Affairs, Portsmouth, VA.
"M Matthew G. Conte, 22, of
.Mogador, OH, died 1 February I
from injuries suffered while his unit
was conducting combat operation
against enemy forces in Al Anbar
Province, Iraq. Conte was assigned to
2nd Battalion, 3rd Marine Regiment,
3rd Marine Division, III Marine
Expeditionary Force, Kaneohe Bay,
HI, serving in Iraq under the command of I Marine
Expeditionary Force (forward).
HM Kyle A. Nolen, 21, of Ennis, TX,
died 21 December from injuries
suffered as a result of enemy action in Al
Anbar Province. Nolen was assigned to
3rd Battalion, 4th Marine Regiment, 1st
Marine Division, I Marine Expeditionary Force,
Twentynine Palms, CA
L CDR Jane E. Lanham, MSC, 43, of Owens-
boro, KY, died 19 September 2006 of natural
causes. Lanham was assigned to the Naval Branch
Health Clinic, Bahrain.
Korean War Medical Personnel and Patients Tell Their Stories
For better or worse, Americans have defined military medicine during the Korean War by a novel, a movie, and a
long-running TV show. But was the Korean War really like M*A*S*H? This was the war characterized by inno-
vation — helicopters swiftly airlifting wounded patients from the battlefield to medical care, the first large-scale use
of antibiotics during wartime, and the pioneering practice of vascular surgery that saved many a limb from amputa-
In a new book, Frozen in Memory: U.S. Navy Medicine in the Korean War by Navy Medical Department
Historian, Jan Herman, both Navy medical personnel and their patients recount their "forgotten war," the dirty
little conflict that somehow has fallen through history's cracks since it was fought more than 50 years ago. Neo-
phyte physician Henry Litvin describes how he practiced medicine during the Chosin Reservoir campaign while
trying to survive 30-below-zero temperatures and a ferocious enemy bent on annihilating him and his comrades.
Hermes Grillo, a Harvard Medical School graduate, recalls how he ended up a few miles from the front operat-
ing on scores of mangled young men — without the benefit of x-ray equipment — and forced to use retractors
made from the brass of discarded artillery shells. Physician Clifford Roosa remembers the day an accidental
explosion aboard his ship snuffed out the lives of 30 men in an instant. The legendary Dr. Joel Boone, World
War I Medal of Honor recipient, tells how he came up with the idea of equipping hospital ships with helicopter
landing decks. And Pearce Grove, once a machinist's mate aboard USS Consolation, gives an account of the his-
toric first-ever landing of a patient-carrying helicopter aboard one of those gleaming white ships. Sarah Griffin
Chapman, a former Navy nurse who lost a leg in an accident before Korea, reveals how she fought to be recalled
to active duty so she could teach young amputees like herself to walk again. Sergeant John Fenwick, a Marine
who had nearly been torn to pieces by a North Korean machine gunner, details his rescue by a Navy corpsman
and the long road to recovery from his wounds. That corpsman, Glen Snowden, relates the same story from his
own perspective. Was the Korean War really like M*A*S*H? In Frozen in Memory, the caregivers and patients
answer that question.
Frozen in Memory is Herman's second book of a planned trilogy. Battle Station Sick Bay: Navy Medicine in
World War //was published in 1997. Into the Dragons Mouth: Navy Medicine and Vietnam is due out in 2008.
Frozen in Memory is available through Booklocker (http://www.booklocker.com).
Navy Nurse, Teacher, Mentor, and Friend
CDR Patricia Rushton, NC, USNR (Ret.)
CAPT Juel Loughney, NC, USN, has witnessed the
progress of Navy medicine for over 40 years. Her
experiences prepared her to support, encourage,
and advocate for patients, colleagues, and friends. Her
story reflects the experiences of many nurses who have
served in the Navy Nurse Corps.
Juel Loughney graduated from Pittston Hospital School
of Nursing in Pittston, PA, in 1956. While working as staff
at the hospital she enrolled at College Misericordia in Dallas,
PA, in an RN BSN completion program. After receiving her
degree, she was asked to teach at the Pittston Hospital School
of Nursing and remained on the faculty teaching medical sur-
gical nursing for 7 years.
CAPT Loughney's desire had always been to be a Navy
nurse. However, she waited 10 years after graduation to join
the Navy. With both parents dead, and being the oldest of
eight, she felt she first had to raise her four younger brothers.
Juel was sworn in as a lieutenant in October 1966. This
began a long career filled with service to others. "This had
been my desire for years," she later related. "At age 31,1 went
into the Navy. One of the greatest highlights of my life, be-
sides becoming a nurse, was joining the Navy."
CAPT Loughney's first duty station was Naval Hospital
Annapolis, a significant assignment for a nurse brand-new
to the Navy. She used the experience to learn about the
Navy, the Navy medical system, and, perhaps, unconsciously,
some of the nuances and subtleties of Navy organizational
structure. These were skills that would help her advocate for
patients and colleagues later in her career.
"One of my responsibilities," she recalls, "was detail-
ing corpsmen to Vietnam. It was heartbreaking because the
turnover of corpsmen was so fast and furious. You got these
young people right from corps school who hardly knew their
way around, and in 2 months I was sending them to Viet-
nam. That was very hard for me. I'm sure people today feel
the same way."
In 1968, then LT Loughney received orders for Vietnam.
As with so many other military nurses, she asked to go to the
area of armed conflict. The request was made from a desire to
serve sailors and Marines at the battle front.
Assigned to USS Sanctu-
ary (AH- 17), a hospital ship
stationed off the coast of
Vietnam, she now recalls car-
ing for many patients with
malaria, of how ill they were
with high fevers, and how
some died before they could
be successfully treated. She
remembers having to make
critical decisions about the use
of resources in order to treat
those patients. She talks about
caring for the many patients
with multiple injuries, specifically those with single or mul-
tiple amputations. One specific patient stands out. "Every
time we thought we would get him stable enough to have
him medevaced back to Japan, he would start bleeding again.
You just knew he was never going to make it. Every time I go
to the Vietnam Wall, I look up his name. He is one that will
always remain in my heart."
LT Loughney spent a year on Sanctuary and returned
home. She subsequently served at Naval Hospital San Diego;
Hospital Corps School San Diego; Naval Hospital Subic Bay,
Philippines; Fresno State University; Naval Hospital Long
Beach; Naval Hospital Great Lakes; and the Bureau of Medi-
cine and Surgery (BUMED) as the Navy Nurse Corps Career
Plans. She was then assigned as Director, Nursing Services at
the National Naval Medical Center Bethesda.
In her long career, she went from staff nurse to supervisor
to assistant chief nurse and director of nursing service. Juel
notes how her experience at BUMED prepared her for the
new position at Bethesda. "There were many positive aspects
being at BUMED that were very helpful to me. For 2 years I
was fascinated with politics. It prepared me well when I went
CAPT Loughney was deeply concerned about the respon-
sibility involved in taking on this assignment of director of
nursing service. She was responsible for the deployment of
nursing service personnel on USNS Comfort (T AH-20) and
was Director of Nursing Service as the ship served in the Per-
sian Gulf during Operation Desert Shield and Desert Storm.
She completed her 29-year active duty career as the Execu-
tive Officer and Acting Commanding Officer of the Clinics
Command, Newport, RI.
Juel Loughney has been a mentor and advocate for col-
leagues and Navy nursing since the beginning of her naval
career. As a junior nurse aboard Sanctuary, she assisted other
nurses and corpsmen to deal with the devastation of that war.
To a nurse colleague who said, "When we leave this office, I
leave my sense of humor behind." Juel responded, "Once you
get out there that's when you really need a sense of humor."
After her experience in Vietnam and her assignment to
corps school in San Diego, she recalls that, "We were still
getting the Vietnam casualties back. Corps school was an eye-
opener for me. I had taught for many years, but had a great
appreciation for corpsmen at that point. I had the experience
then to tell them what they needed to know and learn while
they were in corps school."
When Comfort was deployed for Desert Storm, CAPT
Loughney was responsible for over 700 people. Her job was
to prepare the ship and the nursing staff to function effec-
tively and efficiently to provide the best possible care. She
also had to support the staff emotionally in a time of crisis.
"I had meetings with the nurses once a week, and every other
week with the corpsmen. I would talk about what was going
to happen and what we were going to do. It was a good time
for them to vent. It was very helpful. They would say, 'CAPT
what's going to happen if we hit a mine?'
"I said, "You know the Persian Gulf is very shallow. If we
hit a mine we are not going to sink very far.
"I can remember the day we were heading up north to
Kuwait. I walked outside my office and a line of corpsmen
confronted me — all these young faces with their eyes looking
up as if to ask, 'What's going to happen?' I don't know what I
said to them. When I had talked to the nurses, of course, we
laid things out. I talked to them as plain as I could."
Fellow nurse Susan Jackson notes that when Juel returned
from Desert Shield and Storm as Director of Nursing Service
at NNMC Bethesda, she opened up the Navy Nurse Corps
birthday party to all "my nurses" — military, civil service,
and contract. She made everyone feel special and part of the
Juel Loughney is also friend and mentor to CAPT Eliza-
beth Barker. Barker recalls how her friend taught her how to
handle the politics of command. "Juel knew how to learn the
political situation, how to learn to read it so that you didn't
become a political animal. You just became smart. It's about
keeping your integrity and your soul as a nurse, but not being
stupid about the political situation, so you don't set yourself
up to be a victim. Juel was very smart about that."
Juel Loughney has made so many friends and has been a
friend to so many throughout her Navy career. She remem-
bers the names and relationships with the people who influ-
enced her life. She continues to cultivate those friendships.
She recalls one dear friend she made in Vietnam.
"She had been in Danang and could never make herself
go to the Vietnam Wall. We finally talked her into joining us
in the parade to the Vietnam Women's Memorial. We made
sure she was comfortable. During the time we walked down
Constitution Avenue, some people asked us, 'Were you on
Sanctuary? One patient kept asking, 'Were you in Danang?'
"Somebody said, 'I know a nurse who was in Danang.'
"Then to my friend the nurses said, 'There's a patient over
there. You probably don't know him and you probably never
took care of him, but he wants to meet a nurse who was in
Danang Hospital when he was there.'
"We took my friend to meet him, and she ended up
spending the whole day with him and his family. I think that
made the biggest difference in the world for her. She didn't
have the same fear after that. It was the dread we all had of
looking at that wall and knowing that you took care of many
of the men listed there. I think it was very healthy for her
that day. I think she has gone back a couple of times since
Juel Loughney is herself now struggling with illness. She
has handled the affliction with the same dignity and positive
attitude as with every other crisis she has had to face. Navy
nurses, friends, and family have been constantly at her side-
-caring, supporting, and encouraging. Friends from around
the world have supported her through letters, emails, care
giving, and visits. One physician said to Juel, "With all the
service you have given to others during your lifetime, you
have been given special grace to deal with this disease now."
Juel would like to express her deep appreciation for this con-
stant support, which exemplifies Navy nurses, wherever they
may be. She would also like to share that she and her doctors
are striving toward and are expecting a complete recovery.
CAPT Juel Loughney is the finest example of what nurs-
ing should be. Her willingness to share her knowledge and
experiences with associates, colleagues, friends, and family
has made us all better at whatever we do. We hope that all
who have benefitted by knowing Juel Loughney will continue
that legacy by caring, mentoring, and befriending others.^
This account is part of the Nurses at War Project, an ongoing program
at Brigham Young University College of Nursing. Hie project collects the
accounts of nurses who have served during periods of armed conflict. If
you are a nurse or know a nurse who has served in wartime, and would
like more information on how to participate, please contact CDR Patricia
Rushton, NC, USN (Ret.), RN, Ph.D., at Patricia_Rushton@byu.edu
Hidden in Plain View
CAPT Patricia M. Collins, NC, USNR (Ret.)
No one ever sat down and designed the U.S.
health-care "system." It simply evolved in bits
and pieces. As it now threatens to crack under its
own weight, a Dartmouth Medical School faculty member
is a leading proponent of the need to stop tinkering and
rethink things — from a "microsystem" perspective." (1)
"Clinical microsystems are the front-line units that pro-
vide most health care to most people. They are the places
where patients, families and care teams meet. Microsys-
tems also include support staff, processes, technology and
recurring patterns of information, behavior and results.
Central to every clinical microsystem is the patient" \2)
"The microsystem is the place where:
•Care is made (1)
•Quality, safety, reliability, efficiency, and innovation
are made (2)
•Staff morale and patient satisfaction are made (3).
Microsystems are the building blocks that form hos-
pitals. The quality of hospital care can be no better than
the quality produced by the small systems that come
together to provide care. The hospital quality equation can
be expressed as hospital quality = quality of microsystem
(1) and the quality of microsystem (2) and the quality of
Finding time to improve care can be difficult, but the
only way to improve and maintain quality, safety, efficien-
cy, and flexibility is by blending analysis, change, measur-
ing, and redesigning into the regular patterns and the daily
habits of front-line clinicians and staff. Absent the intel-
ligent and dedicated improvement work by all staff in all
units, the quality, efficiency, and pride in work will neither
be made nor sustained. (3)
Contemporary patient quality and safety literature are
highlighted by the idealized design concepts generated by
the Clinical Microsystems work of Dartmouth College
and the Institute for Healthcare Improvement. Mean-
while, the chronic care model developed by the MacColl
Institute for Healthcare Improvement Innovation at the
Center for Health Studies, Group Health Cooperative is
considered a template for replication across the country
due to its success in physician and patient satisfaction and
positive clinical outcomes. This institute was derived from
Ed Wagner's Improving Chronic Illness Care model.
Wagner's chronic care model identifies the "essential
elements of a healthcare system that encourage high-
quality chronic disease care. These elements are the
community, the health system, self-management support,
delivery system design, decision support, and clinical
information systems. Evidence based change concepts
"within each element "foster productive interactions
between informed patients who take an active part in
their care and providers with resources and expertise. The
model can be applied to a variety of chronic illnesses,
health care settings, and target populations. The bottom
line is healthier patients, more satisfied providers, and
cost savings". "The current five themes incorporated into
the Chronic Care Model are:
•Patient safety (in the Health System)
•Cultural competency (in Delivery System Design)
•Care Coordination (in Health System and Clinical
•Community policies (in Community Resources and
•Case Management (in Delivery System Design) "(4)
Another leader in innovative health care delivery is the
Institute for Family-Centered Care (IFCC). The IFCC
describes its core concepts of patient and family- centered
"Dignity and Respect. Providers listen to and honor
patient and family perspectives and choices. Patient and
family knowledge, values, beliefs, and cultural back-
grounds are incorporated into the planning and delivery
Information Sharing. Providers communicate and
share complete and unbiased information with patients
and families that are affirming and useful. Patients and
families receive timely, complete, and accurate information
in order to participate effectively in care and decision-
Participation. Patients and families are encouraged and
supported in participating in care and decision-making at
the level they choose.
Collaboration. Patients and families are also included
on an institution-wide basis. Health care leaders col-
laborate with patients and families in policy and program
development, implementation, and evaluation; in health
care facility design; and in professional education, as well
as in the delivery of care" (5)
A unique feature of the IFCC is their concept of the
role of patients and family advisors to clinic or hospital
staff on committees and various programs to operational-
ize patient-partnerships. These patient or family advisors
have the potential to reflect a range of experiences within
the unit, hospital or clinic they serve and can provide valu-
able insights into process improvements.
Within the Military Health System is a shining example
of a clinical microsystem and exemplary utilization of the
Chronic Care Illness Model, the Clinical Microsystem,
and Patient-and Family-Centered Care. The WRAMC
Clinical Breast Care Project (CBCP) has executed the
above concepts through their management of care as
described by COL Craig Shriver, Director of the CBCP. (6)
When a patient is first told that she has breast cancer, she
is conceptually unable to "hear" anything else at that time,
due to the immediate emotional impact of such a feared
diagnosis. Therefore, all newly diagnosed patients are seen
on Friday of that week, so that they can have a compre-
hensive multidisciplinary workup and be accompanied by
either their spouse or significant other. When the patient
arrives, she is escorted to a tastefully decorated exam room
that is spacious enough for her spouse to be seated. A
portable screen is used for privacy during physical exami-
nations. Rather than require the patient to travel to all
the specialists for consultation on different days [surgeon,
radiation oncologist, medical oncologist, psychologist,
nutritionist, etc.] , all the specialists see the patient in the
same examination room, in one morning, on a rotating
schedule. If a procedure is required, e.g., tissue biopsy, it is
performed in an adjacent room equipped with a high defi-
nition screen on the ceiling so that the patient may view a
DVD of her choice during the procedure.
Following the complete workup, the patient and her
spouse have lunch, as does the staff. Then, all the special-
ists convene in a conference and along with the Radiolo-
gist and Pathologist to review films and biopsies, review
all their findings as a group. The patient and spouse may
choose whether or not to attend this discussion. Follow-
ing the discussion of the specialists, they meet with the
patient and spouse and present the options specific to her.
This method of physician communication and consensus
avoids conflictual messages to the patient and allows for
the best evidence-based approach. The literature supports
the notion that a group decision is superior to sequential
Additional features of this approach are that the decor
of the unit was designed by a patient council. To a person,
none of them wanted a pink color theme in their breast
center! Instead they chose a rich merlot color and contem-
porary furniture. They also elected to have a waterfall on
one of the walls in the waiting room. The restrooms and
examination rooms have attractive mirrors and potpourri.
Patients who had previously experienced breast cancer care
prior to the CBCP, which opened in 2001 at WRAMC,
are overjoyed at the patient-centered approach. Another
important feature is that the clinic follows these women
for life, which supports their clinical and emotional needs.
The staff turnover is low, which enhances continuity of
the program philosophy, communication, patient safety,
and partnering with the patient and her family. As Chief
of General Surgery, Surgical Residency Program Director,
and Director of the CBCP, COL Shriver has faced the
challenges of the volume of relative value units (RVUs)
generated since only about five patients are seen on the
Friday comprehensive cancer clinics. But then as Einstein
said, not everything that counts can be counted. Certainly
the staff and patient satisfaction, stability of staff reten-
tion, partnership with the patient and her family, and con-
tinuous improvement attitude, creates optimal outcomes
in a safe, high quality, and supportive, attractive physical
environment. As Residency Director, clearly COL Shriver
leads by example and has an impact on physicians during
their graduate medical education by experiencing how
idealized care can be operationalized in a military setting.
This model of care should certainly be considered as the
National Capital Area moves forward with the merger of
Walter Reed Army Medical Center with the National Na-
val Medical Center and becomes the Walter Reed National
Military Medical Center (WRNMMC) in 201 1.
1. http: //www. clinical microsystem.org/content.htm.
2 . http : //cms . dar tmouth . edu/greenB ook. htm
4. http: //www. improving chroniccare.org/change/model/
5. http: //www. institute for familycenteredcare.org
6. Personal communication with COL Shriver ^f
Patricia Collins is Senior Advisor to the Deputy Chief Medical Officer,
TRICARE Management Activity, Falls Church, VA.
TTJM3 Bob Ingraham served with 3rd Battalion, 1st Marines, in QuangNgai
JL JL Province, South Vietnam. On 5 March 1966, the second day of Operation
Utah, his platoon engaged elements of the 21st Regiment of the Peoples' Vietnam
Army, commonly but erroneously known as the NVA — North Vietnam Army.
Operation Utah was the first major engagement between the Marines and regu-
lar North Vietnamese troops. Ingraham was seriously wounded in the ensuing
battle for a hillock named "Hill 50. "
To the Marines of 3rd Platoon of Lima Company,
3/1, the sunny, warm morning of 5 March 1966
hardly seemed dangerous. Just ahead of us Marine
Phantom jets were dropping napalm into what appeared
to be an empty field. But throughout much of the night,
the entire area had been subjected to heavy bombing and
an artillery barrage which no one, it seemed, particularly
the enemy, could have survived. In short, there appeared
to be no direct threat to the platoon at that time.
Our anxiety levels increased when we started receiving
fire from a nearby hill — "Hill 50," whose name I would
learn many years later. The Marines responded with a few
shots. But then word was passed to cease fire — South Viet-
namese troops had fired on us by mistake. We relaxed and
moved up the hill. No one on our side, apparently, knew
that Hill 50 was a maze of tunnels and spider traps. Nor
did they know that we were walking, oblivious, into a trap
set by heavily armed North Vietnamese soldiers.
The assault on 3rd Platoon was sudden and furious.
Second LT [Eugene] Cleaver, our platoon leader, was hit
by a heavy-caliber shell that almost blew his right arm off
at the shoulder. A rifleman had the top of his head blown
off by a rifle or machine gun bullet. A 3rd Platoon ser-
geant sustained a pumping chest wound. Enemy soldiers
we couldn't even see tossed grenades over the high, dense
brush that surrounded us; a Marine hugging the ground
next to me during a grenade attack was put out of action
by a piece of shrapnel that pierced his buttocks.
After doing what little I could for LT Cleaver and the
sergeant, I was told that a wounded Marine was farther up
the hill. I soon found him. His abdomen had been blown
open and his intestines were spilling out onto the ground.
Amazingly, he was still conscious and seemed relatively
calm. I was just beginning to consider what I could do to
help him when a Marine further down the hill yelled, "I'm
gonna throw a grenade over you guys! I'm gonna get that
sniper!" I didn't want to be killed by a Marine grenade, but
as I started to hit the dirt I heard a loud gunshot to my
right. In the same instant I was slammed to the ground by
The bullet hit me on the right side of my right leg
about 6 inches above the knee. It shattered the femur and
blasted out through my inner thigh. It was like a really
big sledge hammer had hit me. I don't remember falling;
I was just instantly knocked flat. I knew I had been shot.
I noticed that my foot seemed to be on backwards. Then
I shouted: "Ski, the bastard shot me!" Ski, another corps-
man, had been nearby when I was shot.
I had enough strength to lower my fatigue pants to
examine the wound. The bullet had left a blue-rimmed
hole on my outer thigh. It was about a third of an inch in
diameter, roughly the diameter of a 7.62mm M14 or AK-
47 round, and was hardly bleeding. (One North Vietnam-
ese soldier who was killed that morning had been using an
Ml 4.) On my inner thigh was a patch of mangled flesh a
few inches in diameter where the bullet, or what was left
of it, had exited my thigh. It looked like fresh hamburger.
Just a trickle of blood oozed from it; my femoral artery
had apparently escaped damage. I could wiggle my toes: I
had no major nerve damage.
In case I started bleeding heavily, I removed my belt
and put it around my thigh to use as a tourniquet, but I
was quickly losing strength and couldn't tighten it. Fortu-
nately, I didn't need a tourniquet.
I tried to give myself some morphine, which we corps-
men carried in our Unit 1 medical bags, but I was so
rattled that I forgot to puncture the seal of the foil syrette.
When I tried to inject myself, the tube burst in my hand.
It was the only syrette I had.
The battle was still going full blast. Nearby, a hidden
rifleman continued to shoot, and I assumed he was the
one who had shot me. I could hear him operating his rifle
bolt. Rockets and grenades were exploding and the sound
of rifle and machine gun fire was constant. It seemed that
every time an enemy rifle fired, a Marine screamed. I
began to fear a "human wave" attack, so I took out my .45
pistol and held it on my chest, determined to kill the first
Vietnamese I saw.
Eventually, a Marine crawled up the hill to try to help
us: he was shot through the shoulder. So now there were
three of us lying there. The Marine with the open abdomi-
nal wound kept asking me if he was going to die. I tried
to reassure him, but I don't know to this day whether he
lived. Another Marine crawled up the hill to help us and
was also shot.
It wasn't long before I was almost completely incapaci-
tated, not so much by pain but by extreme discomfiture,
for want of a better word. The sun was high overhead and
intense. My thighs were getting seriously sunburned. (I
had not been able to pull my pants back up after lowering
them to see my wound.) I was sweating profusely. My skin
became ultra-sensitive to touch. Even small bits of debris
falling out of the sky from explosions resulted in pain. My
entire body began to vibrate. It was as if every cell in my
being was charged with electricity. It's hard to describe,
but maybe there aren't any words for what I was feeling.
Soon I began getting painful cramps in the muscles of not
only my wounded leg, but my good leg as well.
A corpsman eventually reached us and managed to put
a battle dressing on me. The shooting had slowed by then.
Finally, I was half-carried, half-dragged down the hill on
my poncho. I screamed every time my butt hit a bump.
I don't think I'd been given any morphine. With every
bump, I could feel the shattered ends of my femur grating
inside my thigh. I feared they would cause more bleeding.
At the base of Hill 50, helicopters were starting to
arrive to evacuate the wounded. I talked with
the Marines. One Marine was crying. His best
friend had just been killed before his eyes. I asked
someone to take a picture of me, and I took one
of him. The picture of me shows me holding my
helmet tight to my head. I recall being afraid as
bullets were still flying.
Eventually I was flown to a nearby field hos-
pital. The corpsmen bandaged my wound more
thoroughly, immobilized my leg in a splint, and
packed me off to the hospital ship USS Repose
I don't remember arriving on the Repose, but
recall lying on a gurney in a dark passageway for
what seemed an endless period. It must have been
late afternoon or early evening when surgeons
finally operated on me. My femur was badly frac-
tured. An x-ray shows shattered pieces of bone and frag
ments of the bullet lodged in my muscles. The exit wound
on my inner thigh told just part of the story. The muscle
for several inches around the exit wound—and all the way
down to the femur—had been turned to pulp by the bullet
and had to excised. Skin and some muscle around the en-
trance wound had to be trimmed away as well. I received
two units of whole blood during the surgery.
When I left the OR, I had some new hardware— a
threaded steel rod that went completely through my right
shin about 6 inches below my knee. Later, it would be
used as an anchor point for traction, which would stretch
my thigh muscles and hold my femur at its original length
while it healed.
Following surgery, the wounds were packed with cot-
ton and thoroughly wrapped with bandaging. Next I was
encased in plaster from my right foot all the way up to
my armpits and down to my left shin. I was ready to be
shipped home like a parcel.
I don't recall much about my short time on the Repose.
I probably was getting morphine or Demerol regularly;
I don't remember being in pain and I slept a great deal. I
was probably also on antibiotics at this time. Any gunshot
wound is a dirty wound by definition and subject to infec-
A bar hung from a frame over my bed that I could chin
myself on, but its main purpose was to make it easier for
me to use a bedpan. However, it also allowed me to raise
myself higher so I could see the ocean through a nearby
porthole. The Repose steamed constantly in big circles, or
so it seemed to me, but I have been told by a former Re-
pose crewman that the ship sailed back and forth between
Chu Lai and Da Nang.
HM3 Ingraham lies seriously wounded as the battle continues
I wrote a letter to my parents a day or two after the
surgery. In handwriting even worse than my normal bad
scrawl, I described the battle, explained how I was shot,
and told them that my recovery would be long. I did not
mention that I might lose my leg. I'm not sure that I my-
self was aware of just how serious my wound was.
After 2 or perhaps 3 days on the Repose, I was flown
to Danang. The next morning personnel bundled me on
board a C-130 Hercules, which flew to Clark Air Force
Base Hospital in the Philippines where I would stay over-
night. I was able to talk to my parents from the hospital
via a telephone-ham radio link. Until that call, they did
not know I had been wounded.
The next morning I was taken out to the airfield and
put on a huge C-141 Starlifter. I recall little about that
flight, but remember being in a huge, dark, noisy cavern
filled with stretchers. Nurses and medics ran back and
forth constantly. I had little pain but infections were rag-
ing in my wound and in my bladder. The bladder infec-
tion apparently came from poor procedure when I was
catheterized on the Repose. I assumed that most of the
wounded on the Starlifter were Marines from Operation
Utah, but not until years later would I learn just how bad
the casualties were. Historical records are not in full agree-
ment, but it is clear that at least 94 Marines were killed
and some 278 were wounded.
According to the 3rd Battalions "Combat Operation
After Action Report" dated 11 March 1966, 42 Marines
were killed and at least 100 were wounded. Ten Lima
Company Marines had been killed and 20 wounded,
The aircraft landed in Hawaii and an officer came on
board to hand out Purple Hearts. My next memory is be-
ing at the hospital at Travis Air Force Base near San Fran-
cisco. A day later I had arrived back at the Naval Hospital
at Balboa Park in San Diego where I had had my Hospital
Corps training. I have fleeting memories of my arrival.
I do remember very clearly, however, when corpsmen at
Balboa removed my cast and the dressing from my wound.
The blood-soaked cotton was firmly stuck to the wound.
When the cotton was removed, it felt like flesh was being
torn away. As soon as the cast came off, I was put into
traction where I would be for the next 111 days.
My infections slowly yielded to antibiotics, and skin
grafts helped to prevent the formation of excessive scar
tissue — but scarcely improved the appearance of my leg!
Early in the summer I received another cast that kept my
right leg immobilized but at least allowed me to hobble
about on crutches. I also got my first liberty and had
my first date with my fiancee, Susan Overturf, who had
started writing to me when the 3rd Battalion was train-
ing in Okinawa. In August, I got a new, smaller cast just
covering my right leg, and got my first leave home to New
Mexico. Then it was back to San Diego for a few more
months. Finally, late in 1966, I was fitted with an ischial
weight-bearing brace and told that I would have to wear
it for the rest of my life. That meant that I would never
again be able to bear weight on my right leg, which could
break easily and might not heal a second time. Instead,
when I stood or walked, I would literally be "sitting" on
the brace, bearing weight not on the leg but on the right
ischial tuberosity, my "sit bone." The brace wasn't com-
fortable, but it gave me a lot of freedom. It was hinged at
the knee so I could sit down. The brace was fitted with a
special shoe which was permanently attached to it, until I
needed new shoes. Very stylish.
I was finally discharged from the hospital in December
and flown to the Veterans Administration Hospital in
Kansas City, Missouri. Susan was already teaching in Kan-
sas City, Kansas, and I planned to enroll at Kansas City
campus of the University of Missouri.
My transfer to the VA hospital came with good news.
An orthopedic surgeon told me my brace was not neces-
sary and that I should throw it away. Susan and I were
married on 27 December 1966. After our honeymoon,
I began taking the brace off while I was at home in our
apartment. I eventually started going out without it. At
first I had a deep limp. The muscles in my right leg had
atrophied and could not easily support my weight. Soon,
however, I was walking almost normally and eventually
was able to enjoy hiking, running, and cross country ski-
The greater task I faced, although I did not know it at
the time, was the task of putting Vietnam behind me. I was
unaware that combat veterans do not necessarily have the
luxury of packaging the past and putting it away in a dusty
attic. It turned out that my greatest challenge lay ahead —
coping with the psychological trauma of combat. <f
Mr. Ingraham is now retired and lives in Vancouver, British Columbia.
Dr. Hermes C. Grillo, noted thoracic surgeon on
the staff of Massachusetts General Hospital,
Emeritus Professor of Surgery at the Harvard
Medical School, Visiting Surgeon at Massachusetts Gen-
eral Hospital, Emeritus Chief of General Thoracic Surgery,
and former Navy surgeon during the Korean War, died 14
October 2006 in an automobile accident near Ravenna,
Italy. He was 83.
Dr. Grillo was born in Boston and raised in Providence,
RI. He graduated from Brown University in 1943 and
Harvard Medical School in 1947. He joined the surgical
house staff of Massachusetts General Hospital that same
Having been part of the Navy's S V- 1 2 program during
medical school, Dr. Grillo had completed 3 l h years of his
surgical residency at Massachusetts General Hospital when
the Korean War broke out in 1950. By that time he had
severed his ties with the Navy but with a looming military
obligation, he rejoined. As he recalled in a 1999 Navy
Medicine interview: "I'd spend one year at sea, and I like
the sea. I pictured myself on a ship in the Mediterranean,
of course—naturally the sun, the Med squadron, and then,
a year in a naval hospital doing something moderately
But just days into his Navy career, LTJG Grillo's aspira-
tions for a Mediterranean tour were dashed when he was
assigned to the Marines. Following orientation at Camp
Lejeune's Field Medical Service School, Dr. Grillo went
with the First Marine Division to Korea. His introduction
to the war was immediate and dramatic.
He arrived at the front in 1951 when medical services
were sorely needed. The Chinese had entered the war
late the previous fall and the conflict had settled down to a
bloody stalemate. The young medical officer was shocked
to learn that he was the only trained surgeon in his sector
of the front. "It was a slaughterhouse because the Marines
went up the hill against bunkers where the North Koreans
were dug in. Occasionally, things would quiet down a
little bit and then we would have another great run. With
our limited personnel it didn't take long to absolutely
LTJG Grillo spent his 8-month tour in Korea with D
Medical Company of the 1 st Medical Battalion, 1 st Marine
Division. It was a far cry from the sterile environment of
Massachusetts General Hospital.
"We had no true operating room lights. Initially, I
learned to operate with a flashlight clipped to the back
of my belt. Sometimes at night the lights would go out
the generators were not dependable, and everyone would
be stumbling around and I would say, 'Reach in my back
pocket and you will find a flashlight.' And somebody
would fumble around. I remember finishing a bowel
anastomosis with this flashlight.
"We had no suction machines. So when I had a belly
full of feces and exudate and twigs and blood, I would just
scoop it out with my hand onto the dirt floor. And then
we would take big abdominal pads and just wipe the belly
out, pour saline in and clean it out as best we could. If
there was a mess of bleeding welling up, all you could do
was to put pressure on things and then slowly work your
way in, because there was no suction of any sort available.
"There were no deep abdominal retractors. There were
all these miserable little things a few centimeters long. I
took some 155mm brass shell cases — which are big and
heavy and long — and I drew on them outlines of retrac-
tors that I wanted. On a piece of paper I drew the curve
I wanted and we took them down to the engineers. They
cut these for me from the heavy brass, bent and filed
them, and these are what we used."
When Dr. Grillo left the Navy wearing a commenda-
tion ribbon with a Combat V, his combat surgical ex-
perience put him in good stead for the rest of his career.
Renowned as a pioneer in thoracic surgery, his 2004 text-
book, Surgery of the Trachea and Bronchi, is now consid-
ered a landmark work in the field. But more importantly,
he will be most remembered for his nearly 60-year career
as both a surgeon, professor, and mentor to countless
students at Massachusetts General Hospital and Harvard.
He will be greatly missed. $
RADM Joseph L. Yon, MC, USN (Ret.) died on 10
February. He was 94 and the oldest Medical Corps
flag officer. Dr. Yon was born in Coraopolis, PA,
on 7 September 1912. He attended Virginia Military In-
stitute and the University of Pennsylvania. He received his
M.D. degree from the University
of Virginia School of Medicine
in 1937 after which he served a
rotating internship at St. Francis
Hospital, Pittsburgh, PA, from
1937 to 1938. He was commis-
sioned as a lieutenant (j.g.) in the
Medical Corps in 1938 and was
assigned to Naval Hospital New-
port, RI. Dr. Yon received his
residency training at Northwest-
ern University and Cook County
Hospital in Chicago from 1 948
to 1949, and at Naval Hospital,
Philadelphia from 1949 to 1951.
Dr. Yon served as medical of-
ficer at several naval hospitals
both in the U.S. and overseas. At
the outbreak of World War II,
he was serving as medical officer
aboard USS Pecos (AO-9) with
the Asiatic Fleet. His ship was
in Manila Bay and engaged in
the withdrawal action of the Asiatic fleet south to Java on
9 December 1941. On 1 March 1942, Pecos was sunk by
After 4 hours in the oily water a passing U.S. destroyer
rescued Dr. Yon and other survivors and took them to Aus-
tralia. "The only thing I had were burns and a fragment in
one knee. I put a couple of stitches in that myself aboard the
destroyer, and that's the only injury I had," Dr. Yon recalled
in a 2003 interview for the BUMED oral history project.
After serving a year ashore at BUMED, Dr. Yon again
went to sea aboard USS Miami (CL-89) as senior medical
officer. He served aboard that vessel until the end of the
Dr. Yon then served as senior medical officer at the Naval
Operating Base, Bermuda from 1945 to 1947 and was then
assigned to Naval Hospital Corona, CA.
After completing his residency
in surgery, he was assigned as head
of the Department of General Sur-
gery at Naval Hospital St. Albans,
NY (1951-1952); Chief of Surgery
and executive officer of USS Con-
solation (AH-15) in Korea (1953-
1954); chief of Surgery, Camp
Lejeune, NC (1954-1960), with
additional duty as executive officer
from 1959 to 1960; commanding
officer, Naval Hospital, Newport,
RI, from 1960-1962; and com-
manding officer, Naval Hospital,
St. Albans, NY (1962 to 1964).
Dr. Yon was selected for flag
rank and assumed command as
commanding officer, Naval Hos-
pital Portsmouth, VA, and District
Medical Officer on the staff of the
commandant, 5 th Naval district.
In 1971 he commissioned the new
Tidewater Naval Regional Medical
Center and became its director.
RADM Yon was the recipient of the Legion of Merit, a
Secretary of the Navy Letter of Commendation with pen-
dant, and the Purple Heart. He also received the American
Defense Medal with Star, Asiatic Pacific Campaign Medal
with seven Stars, American Theater Campaign Medal, World
War II Victory Medal, National Defense Medal, United Na-
tions Service Medal, Korean Campaign Medal, Philippine
Defense Ribbon with one Star, Philippine Liberation Ribbon
with two Stars, Philippine Independence Medal, Philippine
Presidential Unit Citation, and the Korean Presidential Unit
A Look Back
Navy Medicine 1966
HM3 Robert Ingraham recovers from his wounds at Naval Hospital San Diego. His visitor is Navy reservist and actor, Jackie Cooper.
(See story on page 27.)
DEPARTMENT OF THE NAVY
BUREAU OF MEDICINE AND SURGERY
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WASHINGTON DC 20372-5300
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